Note:

Please ensure that no column is left blank; but you may not fill up the column which does
not concern you.

MAHARASHTRA PUBLIC SERVICE COMMISSION

PROFORMA FOR BIODATA
FOR OFFICE USE ONLY
Index No.:_________________
1. File No.__________________________
3

2. Date of Empanelment:______________________

Degree/Diploma/Subject________________________

Code:___________________

4. Specialisation_________________________________

Code:__________________

5.

Code:_________________

Super/Sub Specialisation:______________________

(Only column nos.

to

are to be filled in by the Expert)

6.Please Tick () on Appropriate Box :

Shri

Smt.

Kumari

Prof.

Dr.

7.Full Name

Surname ...................
First Name ..............
Fathers / ................
Husbands Name
8.Date of Birth :
DD

Male

MM

Female

YYYY

9.Gender

10. Please indicate whether serving under Central Govt./State Govt./Autonomous

Organization/University/any other Institution/Pvt. Organization/Central or State Govt.
Undertaking or Self employed
:
_______________________________
11. Present Designation, if serving

_______________________________

12. Name of your Office/Organisation/

Institute/University
:

__________________________________

13. Last Designation and the name of the last Organisation,

if retired from service
:
_______________________________
14. Date / month /year of
Retirement from service

15.Particulars of employment/assignment
taken after retirement from service, if any :

___________________________________________________________
___________________________________________________________
___________________________________________________________

16. Kindly indicate the name of Service to which you belong/belonged e.g. IAS/ IA&AS/
CSS/IFS/IPS/IRS/and other services under Government of India or State Civil
Service or any other service under a state Government or service under any other
autonomous organisation under the state Government/Government of India/Private
Sector/Self Employed
: _________________________________________________________
17. Scale of Pay
:
__________________________________
(If retired, indicate the scale of pay at the time of retirement or the last pay drawn)
18. Present basic Pay
(If still in service)

__________________________________

19.If self employed please indicate

average monthly income :

__________________________________

20. Office Address

:
(If still in service including
employment after retirement)

__________________________________
__________________________________
__________________________________
Dist __________________ State _________________
PIN CODE

21. Last Office Address

:
(If retired and not employed
in any capacity)

__________________________________
__________________________________
__________________________________
Dist __________________ State _________________
PIN CODE

22. Postal Address

:
__________________________________
(If residential address is the
__________________________________
postal address,please indicate so) _________________________________
(Please note that the MPSC will
send all the correspondence
Dist __________________ State _________________
to you at this address)
PIN CODE

23. Telephone No(s) with STD Codes: Office: __________________________

(Strike out if you do not
Residence: ______________________________
have Fax No. or Email)
Mobile : _____________________________
Fax No. Residence:
Email:

__________________

24. Academic/Professional Qualification starting with First Degree or Equivalent : (Example

if you are a scholar with a doctorate in any subject, the first degree will be either BA/BSc
or equivalent)
Sr.
No.
1

DEGREE/
DIPLOMA

YEAR

NAME OF THE
UNIVERSITY/INSTITUTION

SUBJECT:MAJOR/
SUBSIDIARY

2
3
Sr.
No.

DEGREE/
DIPLOMA

NAME OF THE
UNIVERSITY/INSTITUTION

YEAR

SUBJECT:MAJOR/
SUBSIDIARY

4
5
6
7
8
9
10

25. Field of specialisation: ( To be filled in on the basis of Academic Qualifications and Job/
Service Experience only)
(Please see the bottom of this page before filling it up)
Sr.No.

MAIN FIELD

SPECIALISATION

SUPER-SPECIALISATION

# Illustration:
MAIN FIELD OF STUDY

SPECIALISATION

SUPER-SPECIALISATION

MEDICAL SCIENCES

SURGERY

THORACIC SURGERY

MANAGEMENT

PERSONNEL MGT.

INDUSTRIAL RELATIONS

LAW

INTERNATIONAL LAW

LAW OF THE SEAS

26. Jobs/Positions held during the last 15 years including Current/Last position held (Please
state chronologically starting with the job/position held 15 years ago)
Sr.
No.

1
2
3
4
5
6
7
8

Name of the Office/

Organization

Designation

Year
From

To

Job Description

9
10
Sr.
No.

Name of the Office/

Organization

Designation

Year
From

To

Job Description

11
12
13
14
15
Illustration:Field
Sub Field
Nature of Job
Surgery
Orthopaedic Surgery
Teaching
Surgery
Thoracic Surgery
Applied Side
Management
Personnel Management
Research
Civil Engineering
Geotechnical Engineering
Applied Side
Law
Income Tax Law
Applied Side
Chemistry
Analytical Chemistry
R&D
Note: Experience in the field other than Teaching and Research is treated as experience on the
Applied side.
27. If you claim Research Experience, Please indicate:
27.1 Nos. of Independent/Co-Authored
Research Papers Published in
recognized Journals
:__________________________________
27.2 Total No. of Students guided for
Doctoral/Post Doctoral Research :_______________________________
27.3 Total No. of such Students who have
successfully completed Research :______________________________
28. If you claim Experience on the Applied Side(Other than Teaching), Please give a brief
account of Duties performed/being performed by you:

________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
29. Languages Proficiency(Including Foreign Languages):
(Please see the bottom of this page before filling it up).
Sr.No.

Languages

Level of knowledge

Note: In the Level of knowledge Column, indicate Excellent/Good/ Fair.

30. Brief particulars of experience in years as an Expert for Examination Bodies :
(Please see the bottom of this page before filling it up).
Sr
N0.

Level
Experience

30.1

For Conventional /
Descriptive
Examinations

30.1.1

As a Paper Setter
Subject
Medium of Language
No. of Years

30.1.2

As a Examiner
Subject
Medium of Language
No. of Years

30.1.3

As a Moderator
Subject
Medium of Language
No. of Years

30.1.4

As a Chief Moderator
Subject
Medium of Language
No. of Years

30.2

For Objective
Examinations

30.2.1

For Question Setting

Subject
Medium of Language
No. of Years

30.2.2

For Review of
Questions
Subject
Medium of Language
No. of Years

30.2.3

As a Paper Setter
Subject
Medium of Language
No. of Years

S.S.C.

H.S.S.C.

Diploma

Degree

P.
G.

Competitive
Examinations

Others

31.Current Membership of Professional Bodies, if any :

National Level

International Level

32.Awards won, if any (Indicate Year):

National Awards

International Awards

33.Have you ever-faced any Vigilance Enquiry or enquiry by anti-corruption bureau/Central

Bureau of Investigation or any other Investigative Organisation :
Please write YES or NO

_________________

If Yes : Please indicate in brief, the details of the Vigilance Enquiry and outcome thereof
(If exonerated, a copy of the order passed by the competent authority may be furnished)

_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_____
34. Any other information you may like to furnish to the UPSC :

_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_____
DECLARATION
I DECLARE THAT THE ENTRIES MADE IN THE COLUMNS OF THIS PROFORMA ARE CORRECT AND TRUE TO THE BEST OF
MY KNOWLEDGE AND NOTHING HAS BEEN EITHER CONCEALED OR MISREPRESENTED BY ME.
Place:
Date :

SIGNATURE

CERTIFICATE

Certified that, the information given by Shri / Smt./ Kum./ Prof./ Doctor ________________________________________________
is correct to the best of knowledge and he / she is of a high morality, integrity and devotion to the confidential work of Examination
and he / she has no connection with any coaching classes.

Signature of Competent Authority with Seal *

* If Retired please obtain Certificate from the Competent Authority at the time of retirement

########